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View from the Other Side of the Stethoscope: Thanksgiving 2015

No rush to read this. Leave it for when you're off-call. I just want to share my Thanksgiving reflections while they're fresh, hoping they inspire your work as a third-year medicine resident.

As you know, this November marks my silver anniversary—25 years!—of survivorship. And my longest time out of treatment, too. Let's see... wow, eight years and counting. I remember the mid-1990s when, cycling through remissions and recurrences, I expected to go in-and-out of treatment every year for the rest of my life. Back then, I could tell you immediately how many months since my last treatment, the same way I had always known how far along I was while pregnant with you. Writing this letter, I had to stop and calculate how many years.

Sadly, this month also marks a new loss: Dr. S retired from his practice to pursue research full-time. You're going to tell me that it's marvelous to outlive my oncologist's clinical career. Agreed.

But here's the thing: Just as my ties with my sibs will always be special because of our shared childhood, my relationship with my oncologist is irreplaceable for having shared my illness journey. He broke the news to me in 1990; guided my tough medical decisions; facilitated my treatment in clinical trials; and encouraged my efforts to help others through writing.

Beginning decades ago in what was then the relatively uncharted territory of long-term survivorship, I candidly reported my symptoms, and Dr. S believed me. Together we dealt with my side effects and aftereffects, including the invisible wounds of my survivorship, such as the persistent fatigue and cognitive changes.

Envisioning my first appointment with a new oncologist, a few insights for you come to mind. For one, when working up a new patient with chronic disease, honor the journey that led to that first meeting: “You've been through a lot. Your experiences will help us.”

For another, recognize that you'll serve as a repository for shared memories of the ups and downs of whatever comes next. That responsibility sounds onerous, given the number of illness journeys you'll participate in over your career. Let go of that burden—and I don't mean to sound harsh—by remembering that it's not your pain or loss. It's theirs alone, however much you're investing in and caring about what happens.

For you to continue helping patients year after year without burning out, remind yourself that you experience those shared journeys differently than your patients. Focus on how you're using your expertise to make their situation the best it can possibly be: “Together we'll do our best every step of the way, so you can move forward with hope.”

You knew I'd end that sentence “with hope.” I'm forever talking about how hope helps patients get good care and live as fully as possible. But think about this: Life must be uncertain for patients to feel hope, since hope arises only in situations of uncertainty.

Early in my survivorship, I hated the uncertainty about my future health. With no escaping it, I worked hard to accept it and even embrace it. A quarter century later, I'm feeling something new: gratitude for that uncertainty. You see, when faced with unfavorable statistics, the uncertainty gave me reason to have hope, the hope that helped me live.

I'll never feel grateful for my cancer. No, no, no. But since cancer did happen to me, I am grateful for how my heightened sense of uncertainty about tomorrow created a sense of urgency to embrace today and to live more mindfully than I would have had I never been sick.

And I'm grateful that my illness left behind a permanently open spigot of gratitude for not only the milestones and extraordinary moments, but also the mundane. Gazing at each new moon, as well as an eclipse. Walking beside you, whether around our block or down the aisle. Feeling hungry at dinnertime and tired at bedtime. Reading your texts. Sharing a hug.

Jessie, one of the rewards of becoming a physician is the satisfaction of feeling certain about what's wrong with your patients and what you can do. I've watched you develop the knowledge and skills needed to minimize the uncertainty about your patients' diagnoses. I've seen you gain confidence in discussing prognoses and treatment options. That confidence benefits your patients.

When addressing your patients' questions about the likely outcome, help your patients by confidently highlighting the uncertainty and setting the stage for realistic hope: “Nobody can predict the future. A number of outcomes are possible. We'll strive for—and hope for—the best. I'll be here for you, whatever happens.”

Ages ago I stopped asking, “Why me? Why did I get so lucky to be in that Phase I trial?” Too many factors beyond my control led to my taking that fateful fork in the road. Whenever “Why?” surfaces, I channel my unease and survivor's guilt into gratitude that fuels my writing.

We'll miss having you home with us this holiday. But you are exactly where you are supposed to be, doing what you're supposed to be doing. Just know that when we go around our Thanksgiving table and it's my turn, I'll need an extra minute or two. I plan to express my thanks for how the stars lined up to land me in the care of my oncologist, a truly remarkable clinician and one of the kindest people I've ever met. His temperament and style matched my needs perfectly, and he did right by me every step of the way. I'll also express my gratitude for the mystery... for the uncertainty that encourages us all to know both the fragility and the hopes of life, and with that knowledge to live most fully.